Pediatricians Pressured To Drop Parents Who Won't Vaccinate

Dr. Eric Ball examines a healthy 5-day-old patient in his office in Ladera Ranch, Calif. Ball and colleagues decided this week to take only patients whose parents follow the recommended vaccine schedule.

Courtesy of Eric Ball

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Originally published on February 5, 2015 8:15 am

Dr. Bob Sears, a pediatrician in Capistrano Beach, Calif., says that he strongly believes in the protective power of vaccines to save lives. But he's also well-known in Southern California as a doctor who won't pressure parents who refuse to vaccinate their children, or who refuse some vaccines, or who want to stray from the recommended schedule of vaccinations.

"They all come to me because, I guess, I'm more respectful of their decisions, more willing to listen to them," Sears says, "[and to] discuss pros and cons and acknowledge that there are some side effects to vaccines."

Still, as word's gotten out, he says, about the spreading measles outbreak that started at nearby Disneyland, some of his patients who are usually reluctant to vaccinate have been changing their minds — for a variety of reasons.

Caryn Bailey, of Rancho Santa Margarita, for example, says she's become convinced that the risk her 5-year-old daughter might catch measles has risen enough to outweigh any reservations she had about the vaccine.

Bailey's older son was hospitalized as an infant with a high fever after getting a vaccination. He's a healthy 7-year-old now and has caught up with all the recommended shots. But his early experience, Bailey says, led her to ask Sears to slow down the usual vaccine schedule with her daughter.

Then the Disneyland measles cases caught her attention.

"We are annual-pass holders at Disneyland, and we go there a lot," Bailey says. "I just felt like ... I don't know, I was concerned. I was concerned enough that I went in last week, and I had them give her the MMR vaccination."

Sears says some of his other patients are now rethinking their anti-vaccine stance out of fear that their children will be socially isolated — even kicked out of school.

"They don't want [their child] to be singled out as the only unvaccinated kid," Sears says. "Because if measles does hit a particular school, anyone who hasn't gotten vaccinated is asked to stay home for three weeks."

Some other pediatricians in Southern California say they're now starting to get pressure from a different direction — pressure from parents who do vaccinate their kids.

"I have several patients a day who have threatened to leave our practice if we are still going to see patients that are unvaccinated," says Dr. Eric Ball. "They do not want to see patients with measles or whooping cough in our waiting room for fear their baby might get sick from it."

Babies under a year old are vulnerable because they're too young to be immunized. So these parents' worries aren't unfounded, Ball says. Last year 20 infants in his waiting room, he says, were exposed to the highly contagious measles virus.

"It's horrible," Ball says. "And one of the worst things is, the incubation for measles is long — two to three weeks. Parents had to sit at home for 21 days waiting to see if their baby would come down with measles."

The exposure in those cases, he says, had come from just one new patient who wasn't vaccinated — a patient who showed up in the office with a fever and body rash.

Ball says he spends a lot of time these days convincing doubtful parents of the value of vaccines.

"Most of these parents are fearful because they've heard bad stories about vaccines," he says. "So I tell them stories about the way I handle my own children — about the way I vaccinate my own children.

"I tell them about things I have seen as a doctor," Ball says. "I've seen kids die of whooping cough, meningitis, chickenpox. A lot of parents haven't seen that, and they don't have the same fear of these diseases that I do."

This week Ball's pediatric group of 12 doctors and four nurse practitioners has decided to take a harder line. The group unanimously voted to no longer take patients who don't follow the standard immunization schedule.

And they are giving all current patients a warning.

"For our existing patients who have chosen not to vaccinate," Ball explains, "we'll likely give them a set amount of time to come in and discuss with the doctor a catch-up schedule for their vaccinations. If they choose not to catch up on their vaccinations we're going to ask them to find another pediatrician."

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ROBERT SIEGEL, HOST:

Today, we're examining some of the shifting behavior in this country, especially in California, as a measles outbreak continues to spread. We'll be hearing about the response of some schools in the state elsewhere in the program, but we begin with the changing views of parents and doctors. NPR's Patti Neighmond has this report.

PATTI NEIGHMOND, BYLINE: Caryn Bailey lives in Rancho Santa Margarita in Southern California. Her son is seven, her daughter five. When her son was two months old, he was hospitalized with a high fever following a routine vaccination. He's healthy today, but the experience made Bailey skeptical about sticking to the recommended vaccine schedule.

CARYN BAILEY: This was, you know, not something I'm comfortable with. And it's not that I don't believe in vaccinations, it's just that I don't think that they should all be given at the same time to a tiny little baby.

NEIGHMOND: So Bailey decided not to get all the recommended vaccines and to delay others. Her son's now caught up on most vaccines including measles, but Bailey was holding off getting the measles vaccine for her five-year-old daughter until recently.

BAILEY: We are annual-pass holders at Disneyland, and we go there a lot. And I just felt like - I don't know, I was concerned. I was concerned enough that I went in last week, and I ended up having them give her the MMR vaccination.

NEIGHMOND: Bailey's pediatrician, Dr. Bob Sears, says many of his patients are also rethinking vaccines. Some, like Bailey, are worried about their child getting measles, but others are more concerned about being socially isolated.

BOB SEARS: The main reason my patients are coming is 'cause they don't want to get kicked out of school. They don't want to be sort of singled out as the only unvaccinated kid in the class. And, you know, if measles does hit a particular school, anyone who doesn't have the vaccine actually is asked to stay home for three weeks.

NEIGHMOND: Sears says pretty much all of his patients are either not vaccinated at all or pick and choose vaccines and delay others.

SEARS: They all come to me because I guess I'm more respectful of their decisions and more willing to listen to them and discuss the pros and cons.

NEIGHMOND: Sears says he's generally pro-vaccine but does question the schedule. And he doesn't pressure parents who refuse to vaccinate. But among many pediatricians there's a growing unease about unvaccinated patients.

Dr. Eric Ball also practices in Southern California. This week, Ball's group practice unanimously decided to no longer treat unimmunized or under-immunized patients.

ERIC BALL: For our existing patients who have chosen not to vaccinate, we'll likely give them a set amount of time to come in, discuss with the doctor a catch-up schedule for their vaccinations. If they choose not to catch up on their vaccinations, we're going to ask them to find another pediatrician.

NEIGHMOND: That decision results in part from pressure from parents who do vaccinate their children.

BALL: I have several patients a day who have threatened to leave our practice if we are still going to see patients who are unvaccinated. They do not want to see a kid with measles or whooping cough in our waiting room for fear that their baby might get sick from it.

NEIGHMOND: Babies under a year old are vulnerable because they're too young to be immunized. And parents' worries aren't unfounded. Last year, Ball says, 20 infants in his waiting room were exposed to the highly contagious measles virus.

BALL: It's horrible. And one of the worst things is the incubation period for measles is really long - like two to three weeks. So these families had to sit at home for 21 days waiting to see if their baby would come down with measles.

NEIGHMOND: The infants were exposed to an unvaccinated child. And Ball says he spends lots of time trying to persuade doubtful parent.

BALL: Most of these parents are fearful because they've heard bad stories about vaccines. So I tell them stories about the way that I handle my own children - the way I vaccinate my own children.

I tell them about things that I have seen as a doctor. I've seen kids die of whooping cough. I've seen kids die of meningitis. I've seen kids die of chickenpox. A lot of these parents haven't seen that, and they don't have the same fear of these diseases that I do.

NEIGHMOND: It's estimated that one to two out of every thousand patients who get measles will die of complications. The move by Ball's practice is only the latest in a series of announcements by Southern California doctors who say they will no longer treat unvaccinated children. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.